Develop the annual Quality Management Program Description, workplan and annual program evaluation and submit to clients and ValueOptions for review and approval. Ensure Partnership’s compliance with generally accepted quality management principles.

Accountable for the MBHP quality department in the absence of the VP of Quality Management, including assuring the timely completion of all contact deliverables.

Responsible for NCQA accreditation including development of workplan to ensure compliance with all standards, serve as the liaison with ValueOptions quality team and NCQA staff and directs NCQA Project Manager. Ensures all reporting is timely, and that all documentation is complete and timely, meeting all requirements.

Accountable to the Senior Leadership Team for identifying resources required and barriers to maintaining accreditation.

Ensures programmatic compliance with standards established by external accrediting agencies, including facilitating the annual review of the Partnerships policies and procedures.

Works with the Director of Quality Project Analysis to ensure that all projects are completed as required for NCQA accreditation.

Utilizing clinical and regulatory expertise, serves as the Quality Department expert and liaison to the Utilization Management Committee and clinical areas, responsible for the auditing of all denial and appeal files.

Develop and participate in the implementation of an annual strategic training program for network providers, and assume responsibility for the Partnership’s internal quality management training curriculum.

Responsible for the design, measurement and evaluation of quality operations performance indicators and associated reporting per contract requirements and business needs.

Directs the Partnership’s Risk Management Committee and leads the investigation and presenting of all risk cases or suspected cases of fraud and abuse.

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Beacon Health Options

Beacon Health Options is a health improvement company that serves 45 million individuals across all 50 states and the United Kingdom. On behalf of employers, health plans and government agencies, we manage innovative programs and solutions that directly address the challenges our behavioral health care system faces today. A national leader in the fields of mental and emotional wellbeing, recovery and resilience, employee assistance, and wellness, Beacon Health Options helps people make the difficult life changes needed to be healthier and more productive. Partnering with a network of providers nationwide, Beacon Health Options helps people take important steps in the right direction. We help them live their lives to the fullest potential.